Curly toes and claw toes

In brief

Curly toes and claw toes are toe deformities that may be present from birth or become more noticeable during growth. With curly toes, a toe bends, rotates or sits under or over its neighbour; with claw toes, one or more toes have abnormal bending of their joints. They are common and in many cases cause no pain and need no treatment.

Typical age

From birth; some become more noticeable in the first years

Also known as

Curly toes · Overlapping or underlapping toes · Clinodactyly of the foot · Claw toes

What it is

Toes can develop various deformities during growth. Some are present from birth and are related to the baby’s position in the womb, the shape of the tendons or a family tendency. Others become more visible as the child grows.

Curly toes usually affect the smaller toes, especially the fourth and fifth. The toe bends and rotates, often downwards and inwards, so that it may sit partly underneath the neighbouring toe. In other cases, one toe sits on top of another; this is called an overriding toe.

Claw toes show excessive bending of the toe joints, giving them a curled look. They may affect one or several toes and may be flexible or rigid. Claw toes can occur on their own, but when several toes are affected, the deformity worsens or there are other foot abnormalities, it is important to check for muscle imbalance or a neurological cause.

These deformities can run in families, and sometimes several family members have similar-looking toes. Many mild, flexible deformities improve on their own during the first years of life. The outlook depends on the type of deformity, how flexible it is and whether it causes symptoms.

Signs parents may notice

• One toe looks curled, rotated or sits under or over the neighbouring toe.
• The little toe looks shorter or is partly hidden under the next one.
• Several toes have a bent posture, with the joints flexed.
• The child has trouble finding comfortable shoes or complains when wearing them.
• Redness, hard skin or corns appear where the toes rub against each other or against the shoe.
• The deformity becomes more obvious with growth or seems increasingly stiff.
• The child has pain when walking, running or playing sport.

When to see a specialist

It is advisable to see a paediatric orthopaedic specialist if the deformity is marked, does not improve with growth or starts to cause discomfort.

It is especially important to ask for an assessment when:

• The toe cannot be gently placed in a straight position.
• The deformity is getting gradually worse.
• There is pain, calluses, sores or frequent rubbing.
• The child has difficulty wearing ordinary shoes or walking normally.
• Several toes are affected, or there is muscle weakness, an abnormal gait or a history of neurological disease.

When is it urgent?

These deformities are not usually urgent. However, a toe that suddenly changes colour, turns cold or becomes very painful needs urgent medical assessment.

How it is diagnosed

Diagnosis is mainly made through clinical examination. The specialist looks at the position of the toes, the alignment of the forefoot and how the child places the foot when walking.

They also check whether the deformity is flexible —that is, whether the toe can be gently corrected by hand— or rigid. This distinction is key to deciding on treatment.

In typical cases, no imaging is needed. X-rays may be requested if there is persistent pain, significant stiffness, a complex deformity or suspected bone abnormalities. If claw toes affect several toes and come with other clinical signs, possible neuromuscular causes may need to be investigated.

Treatment

Non-surgical treatment

Most mild, flexible curly toes do not need surgery. Many improve on their own during the first years of life as the foot grows.

Non-surgical measures include:

• Observation: monitoring how things progress, especially when the deformity is flexible and causes no discomfort.
• Suitable footwear: shoes with enough room for the toes, which do not squeeze them or force them into an abnormal position.
• Gentle stretching: in some cases, the specialist may recommend gentle exercises to maintain flexibility, without forcing the toe.
• Separators or corrective devices: these may be used selectively if they help the position and are comfortable for the child. Their usefulness depends on the type of deformity and they do not guarantee a permanent correction.

Forcing the toes or using devices that cause pain, marks or sores is not recommended.

For claw toes, treatment depends on the cause. If they are flexible and cause no symptoms, it may be enough to monitor them and avoid narrow shoes. When there are muscle or neurological problems, treatment must be adapted to the underlying condition.

Surgical treatment

Surgery is reserved for cases where the deformity is persistent, rigid or symptomatic, especially when it causes pain, skin problems or difficulty wearing shoes.

For curly toes, one of the techniques used is flexor tendon tenotomy, which releases the tendon that keeps the toe curled. Depending on the deformity, other procedures may be needed to correct the rotation or position of the toe.

For overriding or claw toes, the technique depends on the joints involved, how flexible the toe is and the cause of the deformity. Some children may need the balance of the tendons corrected or procedures on the joints.

The operation is usually done with anaesthesia adapted to the child’s age and the procedure. Many simple corrections can be done as day surgery, without staying overnight in hospital. The technique and timing of surgery are tailored to each patient.

Outlook and recovery

The outlook is usually good for mild, flexible deformities. Many curly toes improve on their own during childhood, whereas rigid deformities are less likely to correct by themselves.

After a simple procedure, recovery is usually fairly quick:

• First two weeks: protecting the operated area, wound care and controlling swelling.
• Between 2 and 4 weeks: check-up and removal of stitches or dressings when appropriate, depending on the technique used.
• Weight-bearing and footwear: after many minor procedures early weight-bearing is allowed in a post-operative shoe, following the specialist’s instructions.
• Back to school: usually within a few days or about a week, depending on discomfort and how much protection the foot needs.
• Sport: usually resumed gradually after several weeks, once the wound has healed and the toe can be used without pain. The exact time depends on the procedure.

A cast is not usually needed for simple corrections. More complex deformities may need longer protection.

Follow-up checks the position of the toe, wound healing and how function develops. Although results are usually satisfactory, some deformities may persist or come back, so expectations and follow-up should be tailored to each child.

This page is for general information and does not replace an assessment by a specialist. If you are worried about your child's foot, talk to their paediatrician or book an appointment.